ECMO & Mechanical Circulatory Support Fellowships

What Is an ECMO/MCS Advanced Fellowship?

Extracorporeal membrane oxygenation and mechanical circulatory support fellowships are post-graduate training programs designed to build focused procedural and management expertise beyond what standard residency or fellowship training provides. The clinical scope includes venoarterial and venovenous ECMO, durable left ventricular assist devices (LVADs), and the growing family of percutaneous temporary support devices — Impella platforms, TandemHeart, ProtekDuo, and intra-aortic balloon pump — as well as the systems-level work of running an ECMO program: transport logistics, circuit management, anticoagulation protocols, and multidisciplinary team coordination.

This is a distinct training niche. Standard adult critical care fellowship, cardiac surgery residency, and even cardiothoracic critical care fellowship each touch ECMO and MCS, but exposure varies enormously by center and is rarely the primary educational focus. An advanced ECMO/MCS fellowship is structured so that the technology is the curriculum, not an elective rotation within it. Applicants typically pursue these programs when their prior training gave them a foundation in cardiac physiology and critical illness but insufficient hands-on volume or independent decision-making authority with these devices.

The field sits at the intersection of cardiac surgery, cardiac intensivism, and interventional cardiology, which is part of why its credentialing infrastructure is still maturing. Understanding that context matters before you apply.

Accreditation Status — Plainly Stated

As of 2025, no standalone ECMO or MCS fellowship holds independent ACGME accreditation. There is no ACGME-recognized subspecialty certificate in extracorporeal life support or mechanical circulatory support. This is not a temporary gap that is about to close — it reflects the reality that ECMO/MCS training currently lives inside larger accredited programs rather than existing as a freestanding accredited pathway.

Training occurs in one of three structural models:

• Within an ACGME-accredited parent program. An adult cardiothoracic critical care fellowship or a congenital cardiac surgery program may have a dedicated ECMO/MCS year that is formally part of the accredited curriculum. The trainee holds ACGME status; the ECMO exposure is built into an accredited program structure.
• As an institutional advanced fellowship certificate. A hospital creates a one-year advanced fellowship in MCS or ECMO outside the ACGME framework. Trainees are clinical fellows or hospital employees, not ACGME residents. The program may be rigorous and high-volume, but the credential is institutional rather than nationally accredited.
• As a dedicated research fellowship with clinical exposure. Some T32 or NIH-funded research positions include substantial ECMO/MCS clinical time. The primary credential is the research training award; the clinical component is structured locally.

The accreditation gap has direct practical consequences. Because these fellowships are not ACGME-accredited, completing one does not in itself create a pathway to a new board certificate from ABIM, ABS, or any other American Board of Medical Specialties member board. Your board eligibility after an ECMO/MCS fellowship is determined entirely by what ACGME-accredited training you completed before it, not by the fellowship itself. A cardiac surgery resident who completes ACGME-accredited CT surgery training and then does an ECMO fellowship is board-eligible in CT surgery; the ECMO year adds clinical expertise, not board eligibility.

What to ask every program directly: Is this position held within an ACGME-accredited program structure? Does completing this fellowship affect my eligibility for any board examination? Is the position funded as a clinical fellow, research fellow, or hospital employee, and what are the malpractice and benefits implications of each? Do not assume; programs vary and the answers carry career-level consequences.

Who Applies: Entry Pathways and Prerequisites

ECMO/MCS advanced fellowships are almost never accessible immediately after medical school or straight out of a transitional year. The clinical and procedural complexity demands a foundation. Typical entry points:

• Post-cardiothoracic surgery residency. CT surgeons who want to lead MCS programs or build an ECMO surgical implant practice. These trainees usually pursue programs with strong operative cannulation and durable LVAD implant volume.
• Post-cardiac anesthesia fellowship. Cardiac anesthesiologists who manage ECMO intraoperatively and in the ICU and want to become the clinical lead for MCS in their institution's cardiac OR or cardiac ICU.
• Post-adult cardiothoracic critical care fellowship. Intensivists managing cardiogenic shock, bridge-to-transplant LVAD patients, and postcardiotomy ECMO. This pathway emphasizes medical management, weaning strategies, and outpatient VAD follow-up rather than operative cannulation.
• Post-pediatric cardiology or pediatric critical care fellowship. Physicians training in neonatal and pediatric ECMO, which is a distinct subspecialty given congenital cardiac anatomy, smaller circuit sizing, and different weaning physiology.
• Post-interventional cardiology fellowship. Cardiologists focused on percutaneous temporary MCS for high-risk PCI and cardiogenic shock, particularly Impella-based support. This is a narrower pathway and often handled through structured proctorship rather than a formal fellowship year.

Hospitalists and emergency medicine physicians occasionally inquire about ECMO training. Candidly, most ECMO/MCS fellowship programs require demonstrated prior procedural training and critical care or surgical experience. Without that foundation, program directors will view an application as misaligned with program prerequisites. EM physicians who manage ECPR (extracorporeal CPR) often gain ECMO exposure through their institution's protocol-based training rather than through an advanced fellowship.

Training Structure and Duration

Most ECMO/MCS advanced fellowships run six to twelve months. Twelve-month programs are more common when the curriculum includes both adult and pediatric tracks, substantial research, or a VAD clinic component. Six-month programs tend to focus on a single modality — either surgical ECMO/LVAD or medical MCS management — and are sometimes structured as a final year within a larger accredited fellowship.

A well-designed program typically rotates through:

• ECMO specialist shifts. Bedside circuit management, troubleshooting oxygenator failure, managing recirculation in VV-ECMO, anticoagulation titration. Often shared with perfusionist and nursing ECMO specialist staff, which builds the team communication skills that program director roles require.
• Cardiac surgical OR. Central and peripheral cannulation for VA-ECMO, durable LVAD implant (HeartMate 3), operative decannulation. Volume here is the variable that separates training programs most sharply.
• Cardiac catheterization laboratory. Percutaneous Impella insertion and management, hemodynamic assessment in cardiogenic shock, right heart catheterization to guide MCS selection.
• Advanced heart failure/VAD outpatient clinic. Driveline management, INTERMACS profile reassessment, bridge-to-transplant decision making, destination therapy counseling. This rotation is particularly important for LVAD-focused trainees.
• ECMO transport team. High-volume adult ECMO centers increasingly run transport programs for cannulating and transferring patients from referring hospitals. This is a logistically complex and high-stakes skill set.

Adult vs. pediatric tracks differ structurally. Pediatric programs sit primarily within children's hospitals with congenital cardiac surgery programs, rotate through PICU and cardiac ICU environments, and place heavy emphasis on neonatal ECMO physiology. Adult programs are centered in quaternary cardiac referral centers. Some programs formally offer both tracks in a combined year; most do not, and the two populations present sufficiently different clinical challenges that trying to achieve competence in both in a single year is difficult.

Core Competencies and Volume Benchmarks

The Extracorporeal Life Support Organization (ELSO) publishes guidelines and training standards that represent the closest thing the field has to a consensus competency framework. ELSO guidelines are the primary published reference for what constitutes adequate training volume and competency; applicants and programs should consult current ELSO documents directly, as guidelines are periodically updated.

Competencies a well-trained ECMO/MCS fellow should be able to demonstrate:

• Independent peripheral VA-ECMO cannulation (femoral arterial and venous) and decannulation
• Central VA-ECMO cannulation (right atrium to aorta) in the operative setting
• VV-ECMO cannulation, including bicaval dual-lumen cannula placement (e.g., Avalon/Crescent) with echocardiographic guidance
• Circuit troubleshooting: identifying and managing clot in the circuit, oxygenator failure, cavitation, and differential hypoxemia in VA-ECMO
• Anticoagulation management: heparin-based and heparin-free protocols, anti-Xa vs. aPTT monitoring, recognizing heparin-induced thrombocytopenia in the ECMO context
• VA-ECMO weaning trials, including use of echocardiography for cardiac recovery assessment
• Durable LVAD implant assistance (operative scrub role) and postoperative management
• Percutaneous Impella placement (CP and 5.0/5.5), repositioning, and weaning
• ProtekDuo insertion for right ventricular support
• Recognition and management of ECMO-related complications: limb ischemia, neurologic injury, hemolysis, bleeding
• Multiorgan failure management on ECMO support

ELSO guidelines specify minimum case numbers for training center certification; programs accredited or affiliated with ELSO centers provide the volume infrastructure against which individual trainee logs are measured. When evaluating programs, ask for the program's annual ECMO initiation volume, the fellow's operative vs. medical management case split, and whether fellows are the primary operator or assistant for cannulations.

Program Directory and Notable Training Centers

There is no single national registry of ECMO/MCS advanced fellowship positions analogous to ACGME's program search. The authoritative starting point is the ELSO registry (elso.org), which lists certified centers by region and volume category. High-volume ELSO-certified programs are the most reliable proxies for training quality because volume drives case exposure and institutional investment in ECMO infrastructure.

In the United States, programs offering the highest ECMO/MCS training volume tend to be concentrated at:

• Quaternary academic cardiac centers with transplant and LVAD programs (typically implanting more than a threshold volume of durable LVADs per year and running active ECMO transport programs)
• Children's hospitals with high-volume congenital cardiac surgery programs for pediatric/neonatal ECMO training
• Academic centers with dedicated cardiogenic shock teams that have protocolized MCS escalation pathways

Centers that have published extensively on ECMO outcomes, cardiogenic shock protocols, or LVAD management in peer-reviewed literature are useful proxies for faculty investment in the field and for training program infrastructure. Reviewing authorship on ELSO guideline documents and on major MCS trials can identify faculty whose programs are likely to have structured advanced training.

When contacting programs, ask explicitly whether they offer a named advanced fellowship track with a defined curriculum and case log expectations, or whether "ECMO training" means elective exposure within another fellowship. These are materially different experiences.

ELSO Certification and Industry Credentialing

ELSO offers center certification and individual training courses. The ELSO basic and advanced ECMO training courses are widely recognized in the field as a foundational credential. Completing an ELSO-recognized training course before applying to fellowship programs signals baseline preparation and is a concrete step applicants can take during their current residency or fellowship. ELSO also designates centers as ECMO Centers of Excellence based on volume and outcome benchmarks.

Industry credentialing operates separately from ELSO. Abiomed (now Abbott) runs a structured proctorship program for Impella devices; physicians must complete this proctorship before independently placing Impella at most institutions. Thoratec/Abbott has analogous requirements for HeartMate 3 LVAD implantation. These are institutional credentialing requirements, not board certifications or academic credentials, but they are operationally required: without them, a physician cannot use these devices regardless of training background.

During an ECMO/MCS fellowship at a high-volume center, trainees typically complete these industry proctorship requirements as part of the program. Confirm this explicitly with the program director. Completing fellowship without meeting industry proctorship thresholds would leave a trainee credentialed by their institution but unable to independently use the devices at a new employer until completing proctorship again.

None of these — ELSO center certification, ELSO individual training course completion, or Impella/LVAD proctorship — constitute ABMS board certification. They are occupational credentials that enable clinical practice. That distinction matters when negotiating an employment contract or academic appointment.

Application Timeline and Process

ECMO/MCS advanced fellowships do not use ERAS, NRMP, or any centralized match system. There is no rank order list and no match day. Applications are made directly to programs, and offers are extended on a rolling, uncoordinated basis.

Practically, this means:

• Start 12 to 18 months before your intended start date. Programs with named advanced fellowship positions fill early, often before positions are formally advertised. Waiting for a job posting is a suboptimal strategy.
• Identify programs through ELSO, conference networks, and faculty contacts. Many positions are filled through relationships built at ASAIO, ISHLT, ELSO annual conference, or SCCM/ATS meetings. Program directors know the field and know each other.
• Typical application materials: CV with a complete procedure log from prior training; personal statement focused specifically on ECMO/MCS exposure to date, defined career goal, and rationale for that specific program; two to three letters of recommendation from cardiac intensivists, CT surgeons, or cardiac anesthesiologists who can speak to your procedural experience; case log if available.
• The personal statement matters more here than in standard ERAS applications. Because programs are small, faculty-driven, and unregulated by a match, program directors are evaluating fit for a specific role. A generic statement will not move an application forward.
• Expect an informal phone call or meeting before a formal interview. Many programs conduct an initial conversation to assess mutual fit before committing to an interview. Treat these calls as interviews.

For the current application season timeline, see the PGY Zero advanced fellowship timeline data page.

Salary, Funding, and Benefits

Compensation for ECMO/MCS fellows varies substantially and is not standardized. The variation reflects the lack of ACGME oversight and the different structural models programs use.

The key variables to clarify before accepting any position:

• Clinical fellow vs. research fellow vs. hospital employee. Clinical fellows at academic medical centers typically receive stipends set by the institution's GME or graduate medical education equivalent office. Research fellows on training grants are paid at NIH stipend levels. Hospital employees receive wages and are subject to different tax, benefits, and malpractice structures. These distinctions affect your tax liability, health insurance, and whether you are covered by the hospital's malpractice policy.
• Whether the position is funded at all. Some ECMO/MCS fellowship positions are unfunded or grant-contingent. A program may offer a position contingent on securing grant funding that has not yet been awarded. Understand the funding basis before resigning your current position.
• Malpractice coverage. Confirm explicitly what malpractice insurance covers your clinical activities. Trainees who are not in ACGME-accredited positions may not automatically be covered under institutional GME malpractice policies.

For current compensation ranges by position type, see the PGY Zero compensation data page, which is updated to the current academic year.

Career Outcomes and Practice Settings

Physicians completing ECMO/MCS advanced training enter a relatively narrow but growing career space. Common post-fellowship roles:

• ECMO program director or medical director at an academic or quaternary community center. This is the most common goal for trainees with a management and operations interest. The role involves protocol development, quality improvement, team training, and clinical leadership for the ECMO service.
• Cardiac intensivist with designated ECMO/MCS lead role. Intensivists who complete this training often join cardiac ICU faculties as the designated expert for MCS escalation and ECMO initiation, holding a specialized niche within a broader critical care practice.
• CT surgery faculty with MCS focus. Surgeons who build practices around surgical ECMO, LVAD implantation, and cardiac transplant programs, often at institutions developing or expanding MCS programs.
• Pediatric ECMO specialist or PICU faculty with ECMO program leadership. Pediatric trainees frequently move into PICU faculty roles with explicit ECMO program responsibilities at children's hospitals.
• Industry roles. Medical science liaisons, clinical training specialists, and physician educators at device companies (Abbott/Abiomed, Getinge, LivaNova) recruit physicians with ECMO/MCS expertise. These positions offer different compensation structures and lifestyle profiles. Physicians considering industry roles should understand the implications for their clinical licensure maintenance and CME obligations.

Academic placement is more common for fellowship completers than community practice in a generalist role, largely because the device volume necessary to maintain competence is difficult to sustain outside high-volume centers. Physicians who train at top-volume centers and then join lower-volume community hospitals may find their skills difficult to maintain independently. This is a realistic constraint worth weighing in career planning.

Pediatric vs. Adult ECMO Training Differences

These are not interchangeable tracks. The physiologic principles overlap, but the clinical populations, circuit configurations, typical diagnoses, and institutional environments differ enough that trainees should commit to one primary track and treat exposure to the other as supplementary.

Pediatric/neonatal ECMO:

• Higher per-program ECMO volumes at major children's hospitals, driven by congenital cardiac surgery and neonatal respiratory failure (meconium aspiration, CDH, PPHN)
• Smaller cannula sizes, different circuit priming, neonatal anticoagulation protocols
• Primary pathways: PCCM fellowship with ECMO concentration, pediatric cardiac surgery
• Bridge-to-transplant in pediatrics involves different waitlist dynamics and smaller device options
• ELSO's pediatric registry data remains among the most comprehensive outcome datasets in the field

Adult MCS:

• Dominated by cardiogenic shock management, postcardiotomy ECMO, and bridge-to-transplant/decision LVAD
• INTERMACS profiling central to patient selection and management decisions
• Larger percutaneous device ecosystem (Impella 5.5, ProtekDuo, TandemHeart) with active clinical trial programs
• Primary pathways: CT surgery, cardiac anesthesia, cardiothoracic critical care, interventional cardiology
• Durable LVAD program management (HeartMate 3, destination therapy, outpatient follow-up) is a major component with no real pediatric analog

Trainees whose residency background is primarily adult cardiac should pursue adult MCS programs. Those with pediatric critical care or pediatric cardiac surgery backgrounds should pursue pediatric-focused ECMO programs. Applicants who attempt to straddle both tracks in a single year risk insufficient volume in either.

How to Strengthen Your Application

Because these programs are small, competitive, and not matched, the marginal difference between candidates often comes down to demonstrated prior exposure and a coherent career narrative. Concrete steps during your current training:

• Complete an ELSO-recognized ECMO training course. The ELSO basic and advanced courses are available to trainees and signal active investment in the field. This is actionable now, during your current residency or fellowship, not something to defer.
• Seek elective rotations at ECMO centers. If your program does not have high ECMO volume, negotiate an away rotation at an ELSO-certified center. Even a four-week rotation produces cases, contacts, and a realistic sense of whether the training environment fits you.
• Build and maintain a case log. Log every ECMO initiation, cannulation, circuit intervention, or MCS device placement you participate in with your role documented (primary operator, first assist, observer). Programs will ask for this, and vague estimates undermine applications.
• Develop a research project. A peer-reviewed publication or podium abstract in ECMO outcomes, cardiogenic shock management, or MCS device comparison strengthens any application and demonstrates the intellectual engagement that ECMO/MCS program directors expect. ASAIO Journal, JTCVS, and Critical Care Medicine publish in this space.
• Attend field-specific meetings. ASAIO Annual Conference, ISHLT, ELSO Annual Conference, and the Society of Critical Care Medicine are the venues where ECMO/MCS faculty network. Presenting a case or abstract and meeting faculty in person transforms a cold application into a warm one.
• Identify letter writers who are credible in the field. A strong letter from a CT surgeon who directs an ECMO program carries more weight than a generic letter from a department chair unfamiliar with MCS. Plan your letter writers deliberately.
• Be specific about your career goal in the personal statement. "I want to build an ECMO program at a regional quaternary center with a cardiac surgery focus" is useful to a program director. "I am passionate about critical care and advanced technology" is not.

Frequently Asked Questions

Does completing an ECMO/MCS fellowship count toward ABIM or ABS board certification?

Generally, no. Because standalone ECMO/MCS fellowships are not ACGME-accredited, they do not contribute credit toward any ABMS board examination. Your board eligibility is determined by your ACGME-accredited residency and, where applicable, fellowship training. An intensivist who completed ACGME-accredited critical care training is board-eligible through that pathway; the ECMO fellowship year adds clinical expertise but does not alter that eligibility. Confirm specifics with the relevant certifying board for your specialty.

Can a hospitalist or emergency medicine physician apply for an ECMO/MCS fellowship?

Rarely, and only with prior procedural and critical care experience that programs can evaluate. Most programs require demonstrated competency in invasive hemodynamic monitoring, critical care management of cardiac failure, and some procedural background. Emergency medicine physicians who manage ECPR protocols within their own institutions typically acquire that exposure through institutional training programs designed for their clinical context rather than through an advanced fellowship. Exceptions exist; the honest answer is that the applicant would need to contact specific programs and make a direct case for their procedural preparation.

Is there a centralized match for ECMO/MCS fellowships?

No. There is no NRMP match, no SF Match process, and no centralized application system for these positions. Applications are made directly to programs, and offers are extended on an uncoordinated rolling basis. This means both that positions can be filled before you apply if you wait too long and that it is acceptable — and sometimes necessary — to hold one offer while waiting for a response from a preferred program. Communicate with programs transparently about your timeline.

Are there international ECMO training programs?

Yes. ELSO has active chapters in Europe (EuroELSO), Asia-Pacific (APELSO), Latin America, and the Middle East. High-volume ECMO centers in the United Kingdom, Germany, Australia, and Japan, among others, have structured training programs. ELSO's international network is the best starting resource for identifying these programs. Physicians trained outside the United States should also investigate how their training will be evaluated for credentialing at US institutions, since an internationally completed fellowship requires institutional credentialing review regardless of the program's quality. Verify current requirements directly with ECFMG/Intealth and official sources for your application year.

How competitive are ECMO/MCS fellowship positions?

Supply is tightly constrained: the number of named advanced fellowship positions at high-volume programs in any given year is small. Demand is rising as cardiogenic shock protocols expand and ECMO programs grow at regional centers seeking to hire trained personnel. Candidates with prior ECMO exposure, a publication record in the field, and connections through conference networks are in a stronger position than those applying without those elements. The honest framing: starting early, building demonstrable experience during your current training, and networking actively through ELSO and ISHLT meaningfully improves your probability of matching to a program aligned with your goals.